Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study
Open Access
- 1 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Medicine
- Vol. 18 (1), 1-12
- https://doi.org/10.1186/s12916-020-01534-9
Abstract
Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function. This study aimed to examine whether women who experience preterm delivery are at increased risk of subsequent chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Using data from the Swedish Medical Birth Register, singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Gestational age at delivery was the main exposure and treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox proportional hazard regression models were used for analysis. The dataset included 1,943,716 women who had 3,760,429 singleton live births. The median follow-up was 20.6 (interquartile range 9.9–30.0) years. Overall, 162,918 women (8.4%) delivered at least 1 preterm infant (< 37 weeks). Women who had any preterm delivery (< 37 weeks) were at increased risk of CKD (adjusted hazard ratio (aHR) 1.39, 95% CI 1.32–1.45) and ESKD (aHR 2.22, 95% CI 1.90–2.58) compared with women who only delivered at term (≥ 37 weeks). Women who delivered an extremely preterm infant (< 28 weeks) were at increased risk of CKD (aHR 1.84, 95% CI 1.52–2.22) and ESKD (aHR 3.61, 95% CI 2.03–6.39). The highest risk of CKD and ESKD was in women who experienced preterm delivery + preeclampsia (vs. non-preeclamptic term deliveries, for CKD, aHR 2.81, 95% CI 2.46–3.20; for ESKD, aHR 6.70, 95% CI 4.70–9.56). However, spontaneous preterm delivery was also associated with increased risk of CKD (aHR 1.32, 95% CI 1.25–1.39) and ESKD (aHR 1.99, 95% CI 1.67–2.38) independent of preeclampsia or small for gestational age (SGA). Women with history of preterm delivery are at increased risk of CKD and ESKD. The risk is higher among women who had very preterm or extremely preterm deliveries, or whose preterm delivery was medically indicated. Women who experience spontaneous preterm delivery are at increased risk of long-term renal disease independent of preeclampsia or SGA. Preterm delivery may act as a risk marker for adverse maternal renal outcomes.Funding Information
- Wellcome Trust (203930/B/16/Z)
- Health Research Board (203930/B/16/Z)
- Swedish Research Council (2018-00932)
- Swedish Research Council (2009-1068)
This publication has 42 references indexed in Scilit:
- A systematic review finds prediction models for chronic kidney disease were poorly reported and often developed using inappropriate methodsJournal of Clinical Epidemiology, 2013
- Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based studyCMAJ : Canadian Medical Association Journal, 2013
- Maternal serum C‐reactive protein in early pregnancy and occurrence of preterm premature rupture of membranes and preterm birthJournal of Obstetrics and Gynaecology Research, 2012
- External review and validation of the Swedish national inpatient registerBMC Public Health, 2011
- Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update: A Guideline From the American Heart AssociationJournal of the American College of Cardiology, 2011
- Late Preterm Birth and Neonatal Outcome: Is 37 Weeks’ Gestation a Threshold Level or a Road Marker on the Highway of Perinatal Risk?Birth, 2010
- Epidemiology and causes of preterm birthThe Lancet, 2008
- Plasma C-Reactive Protein in Early Pregnancy and Preterm DeliveryAmerican Journal of Epidemiology, 2005
- Estimating the date of confinement: Ultrasonographic biometry versus certain menstrual datesAmerican Journal of Obstetrics and Gynecology, 1996
- Reliability of Ultrasound Fetometry in Estimating Gestational Age in the Second TrimesterActa Obstetricia et Gynecologica Scandinavica, 1986